Open AccessTransient topographical disorientation due to right‐sided hippocampal hemorrhage
Author(s) -
Irving Stephanie,
Pradhan Cauchy,
Dieterich Marianne,
Brandt Thomas,
Zwergal Andreas,
Schöberl Florian
Publication year - 2018
Publication title -
brain and behavior
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.915
H-Index - 41
ISSN - 2162-3279
DOI - 10.1002/brb3.1078
Subject(s) - spatial disorientation , landmark , psychology , spatial memory , cognition , cognitive map , neuroscience , gaze , cognitive psychology , computer vision , computer science , working memory , simulation
Topographical disorientation is defined as the inability to recognize familiar or unfamiliar environments. While its slowly progressive development is a common feature of neurodegenerative processes like Alzheimer's dementia, acute presentations are less frequent and mostly caused by strategic lesions within the cerebral navigation network. Depending on the lesion site, topographical disorientation can originate from deficits in landmark recognition and utilization for route planning (egocentric navigation deficit), or disturbance of an overarching cognitive map of the spatial environment (allocentric navigation deficit). However, objective measurements of spatial navigation performance over time are largely missing in patients with topographical disorientation. Methods We here report a 55‐year‐old patient with acute topographical disorientation as the single symptom of right‐sided hippocampal hemorrhage and present quantitative gaze‐monitoring head camera‐based analyses of his path‐finding strategy and visual exploration behavior in a real space navigation paradigm. Results The patient exhibited severe allocentric and also egocentric navigation deficits during the acute phase, shown by higher error rates at finding target items. In addition, he showed a more extensive use of search saccades toward, and fixations on, landmarks that could potentially serve as spatial cues. These deficits had been completely compensated for after four months, when the patient performed unremarkably in the real space navigation task, and used even more strongly allocentric path optimization strategies than age‐matched controls. Conclusions This case report highlights the integral function and right‐sided dominance of the hippocampal formation in the cerebral navigation network in humans. It shows that the cognitive map can be restored completely despite a residual hippocampal lesion, which illustrates the enormous plasticity of the cerebral navigation network in humans.